Does the route of administration of misoprostol make a difference? The uterotonic effect and side effects of misoprostol given by different routes after vaginal delivery

Objective: To compare the postpartum uterotonic effect and side effects of misoprostol administered by different routes. Study design: Fifty women were given misoprostol 400 mug either by the oral solution, oral tablet, rectal or vaginal route, or intramuscular syntometrine 1 ml after spontaneous vaginal delivery. Pre- and post-treatment uterine activity were measured with intrauterine pressure catheters. Results: Uterine activity produced by oral solution misoprostol 400 mug was significantly higher than that of oral tablet, rectal and vaginal misoprostol (P = 0.045, 0.004, 0.002, respectively). Onset of action after oral solution misoprostol was faster than by the oral tablet (P = 0.01), rectal (P < 0.001) and vaginal (P < 0.001) routes. Shivering and pyrexia were most common with oral solution misoprostol. Maximum body temperature recorded was significantly higher with oral solution misoprostol than with oral tablet, rectal and vaginal misoprostol (P = 0.005, 0.009, 0.001, respectively). Conclusion: Different routes of administering misoprostol greatly influence the effects achieved. Oral solution misoprostol produces the fastest and strongest uterotonic effect, with the most side effects. (C) 2003 Elsevier Ireland Ltd. All rights reserved.